原発性アルドステロン症の2例

Abstract

Two cases of primary aldosteronism were reported here in. Case 1. T.T. 40-year-old woman had typical signs and symptoms of primary aldosteronism including hypertension, hypopotassemia, headache, polyuria, polydipsia, muscle weakness and paralysis. Endocrinological work-up satisfied Conn's criteria 1) increased excretion of urinary aldosterone, 29 µg/day, 2) suppressed peripheral plasma renin activity, 0.2 ng/ml/hr, 3) normal urinary 17 OHCS 4.5 mg/day. Aldosterone-producing tumor of the left adrenal was diagnosed by the left adrenal phlebography and also by aldosterone assay of bilateral adrenal venous blood. Left adrenalectomy with cortical adenoma 2.4×1.5×1.5 cm in size was performed by left flank incision. Convalescence was un-eventful. She is symptoms-free for 5 years post-operation with blood pressure 118 mmHg in systoric, with normal serum sodium and potassium 140 mEq/1 and 4.5 mEq/1 respectively. Case 2. S.N. 53-year-old woman suffered from muscle discomfort and periodic paralysis of the extremities since 20 years except in summer. She had conservative treatment for hypertension, headache, paralysis with antihypertensive drugs, spironolactone and potassium chloride these 8 years prior to surgery. Simultaneous measurement of plasma aldosterone and plasma renin activity after 2 hour-erect position and deoxycorticosterone suppression test suggested presence of aldosterone-producing tumor. [131]I-6-iodocholesterol scan demonstrated hot spot on the right adrenal but right adrenal phlebo- graphy failed to show adrenal tumor. Blood sampling from the right adrenal vein was unsuccessful Right adrenalectomy was done by upper abdominal transverse incision, and a cortical adenoma was found which measured 1.9×1.8×1.0 cm in size. Postoperative course was uneventful. She is asymptomatic 1.8 year after operation with blood pressure 120 mmHg in systoric with serum sodium and potassium 140 mEq/l and 4.7 mEq/l respectively.